Despite its ominous ring, shock therapy has been endorsed by several major medical organizations and is being given to thousands of Americans.

For many Americans, electroconvulsivetherapy (ECT) brings to mind the devastating experience of Jack Nicholson's character in One Flew Over the Cuckoo's Nest.

So it's no surprise that after more than six decades of use, ECT, also known as shock therapy, remains a highly controversial treatment for mental illnesses.

Even so, the procedure is now administered to 100,000 Americans a year. The American Psychiatric Association, the American Medical Association, and the National Institute of Mental Health recognize ECT as an effective treatment. Learning about this therapy can help you understand its risks and benefits.

Q. What is ECT and how is it administered?

A: In shock therapy, electric currents are passed through the brain to produce a seizure that lasts around 40 seconds. Experts believe the seizure makes neurotransmitters (brain chemicals that deliver messages fromone brain cell to another) work better. That improves the person's mood and ability to function.

A psychiatrist gives ECT treatments in a hospital setting. The treatments are usually done three times a week for two to four weeks.

Before the treatment, the patient receives an intravenous anesthetic and a muscle relaxer to induce sleep and reduce the risk for injury. After the anesthetic takes effect, an electric shock is applied to the head for a few seconds to cause a seizure. Five to 10 minutes later, the patient wakes up and is taken to a recovery room.

After completing a full round of ECT treatments, most people take antidepressant drugs. Depending on how they're doing, they may receive more ECT less frequently.

Q. What conditions can ECT help?

A: ECT may help people with these illnesses who have not responded to medication or counseling:

• Severe depression
• Severe mania with symptoms such as agitation, confusion, hallucinations, or delusions
• Schizophrenia
• Suicidal tendencies

Q. What are ECT's risks and side effects?

A: ECT's main side effect is cognitive impairment, including shortterm confusion and memory loss. Although the memory loss usually lasts days or weeks, in unusual cases it can extend to months or years. However, it does not appear to affect mental functioning or the formation of new memories.

Other potential side effects include headaches, high or low blood pressure, sore muscles, nausea, and heart problems. Some medical conditions increase the risk for certain side effects, so people considering thetreatment must make sure their doctors know their medical history.

Increased risks of treatment often relate to misusing equipment, failing to train staff properly, or administering the treatment incorrectly. The procedure should only be given by trainedhealth professionals with extensive

ECT experience supported by certified anesthesiologists. The team should carefully monitor the seizure throughout the procedure. ECT can be very effective for many people. Some studies show as many as 80 percent of patients with severe major depression see substantial improvement. But ECT isn't a cure in all cases or for all people. Patients and their families should discuss all treatment options, as well as the risks and potential benefits of ECT, before beginning treatment.

By Barbara Floria, senior writer for Vitality. For more information, visit the American Psychiatric Association at www.healthy minds.org..

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